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Introduction

The following quantitative observational study aimed to analyse the maternal and neonatal outcomes of 90 low-risk pregnant women who gave birth in water at São Bernardo Hospital.

Methods

A form containing information on the obstetric history of the parturient, the type of immersion, and the labour and birth follow-up was used by midwives to collect the data.

Background

The Apgar score (at 1 min after birth) used in this study, called Aqua Apgar, was adapted by Cornelia Enning.

Results

The mean water immersion time was 1 h and 46 min and had an influence on the duration of labour (mean 5 h and 37 min), with a statistically significant difference (P = 0.004). There was a decreased cervical dilatation time and a shorter duration of the expulsion phase. In the immersion scenario, 30% of the women did not undergo any examination to assess the length of the cervix, and 57.8% presented intact perennial areas or first-degree tears. As for neonatal outcomes, during maternal immersion, 97% maintained normal fetal heart rates (between 110 and 160 beats per minute) and Aqua Apgar was higher than 7, both in the first minute (mean of 9.4) and in the fifth minute of life (mean of 9.9).

Conclusion

These safety outcomes, based on sound scientific evidence, should increasingly support and inform clinical decisions and increase the number of waterbirths in health facilities. The results of this study align with growing evidence that suggests waterbirth is a safe delivery option and therefore should be offered to women.  相似文献   
2.

Background

Accessibility of water immersion for labour and/or birth is often dependent on the care provider and also the policies/guidelines that underpin practice. With little high quality research about the safety and practicality of water immersion, particularly for birth, policies/guidelines informing the practice may lack the evidence necessary to ensure practitioner confidence surrounding the option thereby limiting accessibility and women’s autonomy.

Aim

The aims of the study were to determine how water immersion policies and/or guidelines are informed, who interprets the evidence to inform policies/guidelines and to what extent the policy/guideline facilitates the option for labour and birth.

Method

Phase one of a three-phase mixed-methods study critically analysed 25 Australian water immersion policies/guidelines using critical discourse analysis.

Findings

Policies/guidelines pertaining to the practice of water immersion reflect subjective opinions and views of the current literature base in favour of the risk-focused obstetric and biomedical discursive practices. Written with hegemonic influence, policies and guidelines impact on the autonomy of both women and practitioners.

Conclusion

Policies and guidelines pertaining to water immersion, particularly for birth reflect opinion and varied interpretations of the current literature base. A degree of hegemonic influence was noted prompting recommendations for future maternity care policy and guidelines’.

Ethical considerations

The Human Research Ethics Committee of the University of South Australia approved the research.  相似文献   
3.
The active and passive voice allocated to women within maternity service guidelines helps construct the nature of decision making. The aim of this paper is to demonstrate that by allocating women an active voice within practice guidelines serves the interest of all parties within the health care relationship. Clinical guidelines were reviewed, and electronic databases and text were searched. The findings of this paper support that applying the principles of a shared decision making framework, within clinical practice guidelines, can assist the development of a partnership relationship between midwives and women.  相似文献   
4.

Background

There is little published research that has examined practitioners’ views and experiences of pain relieving measures commonly used during labour and birth, particularly for non-pharmacological measures such as water immersion. Furthermore, there is minimal published research examining the process of policy and guideline development, that is, the translation of published research to usable practice guidance.

Aims

The aims of phase three of a larger study were to explore midwives knowledge, experiences and support for the option of water immersion for labour and birth in practice and their involvement, if any, in development of policy and guidelines pertaining to the option.

Methods

Phase three of a three phased mixed methods study included a web based survey of 234 Australian midwives who had facilitated and/or been involved in the development of policies and/or guidelines relating to the practice of water immersion.

Findings

Midwives who participated in this study were supportive of both water immersion for labour and birth reiterating documented benefits of reduced pain, maternal relaxation and a positive birth experience. The most significant concerns were maternal collapse, the difficulty of estimating blood loss and postpartum haemorrhage whilst barriers included lack of accredited staff, lifting equipment and negative attitudes. Midwives indicated that policy/guideline documents limited their ability to facilitate water immersion and did not always to support women’s informed choice.

Conclusion

Midwives who participated in this study supported the practice of water immersion reiterating the benefits documented in the literature and minimal risk to the woman and baby.

Ethical considerations

The Human Research Ethics Committee of the University of South Australia approved the research.  相似文献   
5.
BackgroundThe practice of waterbirth is increasing worldwide and has been a feature of maternity services in the United Kingdom for over twenty years. The body of literature surrounding the practice focusses on maternal and neonatal outcomes comparing birth in and out of water.AimTo undertake a review of qualitative studies exploring women’s experiences of waterbirth. This understanding is pertinent when supporting women who birth in water.MethodsA literature search was conducted in databases British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Maternity and Infant Care, Medline, Applied Social Sciences Index and Abstracts and Web of Science, using search terms waterbirth, labour/labor, childbirth, women, mothers, experience, perception and maternity care. Five primary research articles published between 2003 and 2018 which explored the views of women who had birthed in water were selected for inclusion. Using meta-ethnography, qualitative research studies were analysed and synthesised using the method of ‘reciprocal translational analysis’ identifying themes relating to women’s experiences of birthing in water.FindingsFour themes were identified: women’s knowledge of waterbirth; women’s perception of physiological birth; water, autonomy and control; and waterbirth: easing the transition.Discussion and conclusionDespite the paucity of qualitative studies exploring women’s experiences of waterbirth, meta-synthesis of those that do exist suggested women identify positively with the choice. The experience of birthing in water appears to enhance a woman’s sense of autonomy and control during childbirth suggesting waterbirth can be an empowering experience for women who choose it.  相似文献   
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BackgroundApproximately 30% of Australian women use epidural analgesia for pain relief in labour, and its use is increasing. While epidural analgesia is considered a safe option from an anaesthetic point of view, its use transfers a labouring woman out of the category of ‘normal’ labour and increases her risk of intervention. Judicious use of epidural may be beneficial in particular situations, but its current common use needs to be assessed more closely. This has not yet been explored in the Australian context.AimTo examine personal, social, institutional and cultural influences on women in their decision to use epidural analgesia in labour. Examining this one event in depth illuminates other birth practices, which can also be analysed according to how they fit within prevailing cultural beliefs about birth.MethodsEthnography, underpinned by a critical medical anthropology methodology.ResultsThese findings describe the influence of risk culture on labour ward practice; specifically, the policies and practices surrounding the use of epidural analgesia are contrasted with those on the use of water. Engaging with current risk theory, we identify the role of power in conceptualisations of risk, which are commonly perpetuated by authority rather than evidence.ConclusionsAs we move towards a risk-driven society, it is vital to identify both the conception and the consequences of promulgations of risk. The construction of waterbirth as a ‘risky’ practice had the effect of limiting midwifery practice and women's choices, despite evidence that points to the epidural as the more ‘dangerous’ option.  相似文献   
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